Chapter 10 — Quiz

Twenty-two questions. Verify all codes currently.


Multiple choice

1. Sepsis with no documented acute organ dysfunction requires:

  • A. the underlying infection code only
  • B. the infection code plus a severe sepsis code
  • C. a severe sepsis code sequenced first
  • D. a septic shock code

2. In every sepsis encounter, sequenced first is:

  • A. the severe sepsis code
  • B. the underlying systemic infection
  • C. the organ dysfunction
  • D. the reason for admission

3. Severe sepsis requires documentation of:

  • A. a positive blood culture
  • B. acute organ dysfunction associated with the sepsis
  • C. intensive care admission
  • D. septic shock

4. Organ dysfunction documented but not documented as associated with the sepsis:

  • A. is assumed to be related
  • B. is a query
  • C. requires R65.20 anyway
  • D. is not coded at all

5. Once a patient has been assigned B20:

  • A. they revert to Z21 when asymptomatic
  • B. B20 applies to all subsequent encounters
  • C. the inconclusive serology code applies
  • D. Z21 and B20 are reported together

6. "Uncertain behavior" in the Table of Neoplasms means:

  • A. the coder is uncertain
  • B. the pathologist could not classify the neoplasm
  • C. the documentation is silent
  • D. the site is unknown

7. "Unspecified behavior" means:

  • A. the pathologist could not classify it
  • B. the documentation does not state the behavior
  • C. the neoplasm is benign
  • D. metastatic disease

8. A patient presents solely for chemotherapy. Sequenced first:

  • A. the malignancy
  • B. the encounter code for the chemotherapy
  • C. any anemia
  • D. the adverse effect

9. A malignancy is coded as personal history (Z85) when:

  • A. treatment ended
  • B. it was excised or eradicated, there is no further treatment to the site, and no evidence remains
  • C. five years have passed
  • D. the patient is in remission

10. When diabetes type is not documented, the default is:

  • A. type 1
  • B. type 2
  • C. drug-induced
  • D. unspecified

11. The "with" convention permits linking diabetes to:

  • A. any clinically plausible condition
  • B. the conditions the classification links under "with"
  • C. any condition on the problem list
  • D. no conditions without explicit documentation

12. "Anemia in neoplastic disease" carries an instruction to:

  • A. code the anemia first
  • B. code first the neoplasm
  • C. use an additional code for the anemia
  • D. omit the neoplasm

13. A G89 pain code is sequenced first when:

  • A. pain has lasted over three months
  • B. the encounter is for pain management rather than the underlying condition
  • C. the site is unknown
  • D. the pain is postoperative

14. ICD-10-CM defines chronic pain by:

  • A. three months' duration
  • B. six months' duration
  • C. no duration rule — the provider's documentation governs
  • D. the site involved

15. Routine postoperative pain is:

  • A. always coded
  • B. not coded; it is expected
  • C. coded with G89 only
  • D. coded as a complication

Short answer

16. State the six-step method for entering an unfamiliar body system.

17. State the two conditions that must both be met before adding an organism code.

18. Give the sepsis sequencing rules in order, and name the most common error.

19. Distinguish "uncertain behavior" from "unspecified behavior," and say why the distinction matters.

20. State the three conjunctive conditions for a Z85 history code.

21. (Chapter 9) A note documents type 2 diabetes and stage 3a CKD with no stated linkage, and both are addressed at the encounter. May you use the combination code? Name both questions involved.

22. (Chapter 4) A coder assigns a chronic pain code because the pain has lasted eight months. Name the error and the rule it violates.


Answer key **1.** A. **2.** B. **3.** B. **4.** B. **5.** B. **6.** B. **7.** B. **8.** B. **9.** B. **10.** B. **11.** B. **12.** B. **13.** B. **14.** C. **15.** B. **16.** (1) Read the chapter-specific guidelines in Section I.C. (2) Read the chapter's opening notes in the Tabular. (3) Skim the block headings. (4) Find the combination codes. (5) Find the sequencing rules. (6) Code the chart, index to Tabular. **Step 1 is skipped most often and is the highest-yield.** **17.** **The Tabular must instruct it** ("use additional code to identify the infectious agent"), **and the organism must be documented.** Both. Where the organism is not documented, code the infection without it. **18.** (1) Code the underlying systemic infection **first**, always. (2) Sepsis alone gets **no** severe sepsis code. (3) Severe sepsis requires the infection code, plus R65.20 or R65.21, plus a code for **each** acute organ dysfunction. (4) The organ dysfunction must be documented **as associated with** the sepsis; if not, **query**. **The most common error is adding a severe sepsis code where no organ dysfunction is documented.** **19.** **Uncertain behavior** is a **pathological conclusion** — the specimen was examined and could not be classified as benign or malignant. **Unspecified behavior** means **the documentation is silent.** The distinction matters because using the uncertain column when *you* are uncertain reports a pathological finding that was never made. **Only the pathologist's uncertainty is codeable; yours is not.** **20.** The malignancy was **excised or eradicated**; there is **no further treatment** directed to that site; and there is **no evidence of any remaining malignancy** at that site. **All three**, or it is still active. **21.** **Yes.** Two questions: the **linkage** question — may these be coded as related without an explicit statement? The "with" convention says yes, because the classification links them. And the **addressed** question — were both addressed at this encounter? Here, yes. **Both questions are answered affirmatively, so the combination code applies** — plus the CKD stage code, which the Tabular instructs additionally. *(Contrast Account 10-4471, where the linkage question is the same and the addressed question is answered **no**, which is why that file is coded E11.9.)* **22.** **The error:** applying a duration rule the classification does not have. ICD-10-CM does **not** define acute versus chronic pain by duration; the **provider's documentation governs.** **The rule violated:** Chapter 4 §4.7 — a coder may not supply what the record does not state, and "it has been going on for eight months" is inference. If the record says chronic, code chronic. If it says nothing, do not supply it.